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COVID-19 - What Providers Need to Know

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Coverage Updates

At Quartz, we're doing all we can to keep you informed during this pandemic. We have several updates on extended timelines for fully insured commercial members.

Extended timelines on coverage with no out-of-pocket costs

COVID-19 viral testing:

  • For Quartz commercial members, there will be no copay, coinsurance, or deductible for medically necessary* COVID-19 tests ordered by a provider in our network through the end of the Federal Public Health Emergency.
  • For Quartz Medicare Advantage members, there will be no copay, coinsurance, or deductible for medically necessary* COVID-19 tests ordered by a provider in our network through the end of the Federal Public Health Emergency.

COVID-19 antibody testing:

  • Medically necessary* tests ordered by an in-network provider will continue to be covered through the end of the Federal Public Health Emergency.

*Medically necessary tests include tests for members with known or suspected symptoms, known or suspected exposure, and those entering health care facilities for service.

Third-party screening tests for employment, school admission, or travel are not covered

As you can see, we cover tests ordered by a provider to meet members’ medical needs. We do not cover screening tests requested by third parties, such as those for employment, school admission, or travel:

  • Tests requested for return to work, school, or participation on a sports team are typically paid for by the organization requesting them or by the person receiving the non-covered service.
  • Tests conducted at public health sites and at-home tests, whether conducted at home or sent to outside labs for analysis, are not covered by Quartz.

COVID-19 vaccines are covered 100% with $0 cost-share

Vaccinations and administration costs for COVID-19 are covered with a $0 cost-share for all Quartz members. The cost of the COVID-19 vaccine will initially be paid for by the federal government and should not be submitted to Quartz for reimbursement.

See below for guidance on billing for the administration of the COVID-19 vaccinations.

  • Medicare Advantage: Providers should follow CMS guidance and submit claims for administering the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) for payment. 
  • Commercial Employer Groups and Individual Plans: Quartz will cover the administration of the COVID-19 vaccines with a $0 cost-share. Please bill using the newly published vaccine-specific CPT administration codes.
  • Medicaid: Providers should follow guidance issued by the state when submitting bills for the COVID-19 vaccine administration.

Monoclonal Antibody COVID-19 Infusion

Quartz will not provide payment to providers for the monoclonal antibody products that they receive for free.

  • Medicare Advantage: Providers should follow CMS guidance and submit claims for the monoclonal antibody COVID-19 infusion to the CMS Medicare Administrative Contractor (MAC) for payment.
  • Commercial Employer Groups and Individual Plans: Quartz will provide reimbursement at contracted rates for the monoclonal antibody's infusion cost to treat COVID-19. Normal member cost-sharing will apply. Please bill using the antibody-specific CPT infusion codes.
  • Medicaid: Providers should follow the state's guidance when submitting claims for the monoclonal antibody infusion to treat COVID-19.

Telehealth Visits and Virtual Visits have returned to their usual cost-share.

To help during difficult times, Quartz waived member cost-share for telehealth visits and virtual visits through December 31, 2020. This benefit enhancement ended for most members* with the start of the new year. Members now pay their usual out-of-pocket costs.

*Members on an Illinois-licensed policy have $0 cost-share through the end of the Illinois Disaster Proclamation.

Alternative Care Options

To appropriately apply benefit coverage for your patients, all provider telehealth claims must have at least one of the telehealth modifiers listed below.

Telehealth Modifiers:

All telemedicine claims must have at least one of these indicators:

Modifiers 
  • 95 - Telemedicine Service
  • GT - Via Interactive Audio and Video Telecommunication System
  • GQ - Via Asynchronous Telecommunication System
  • GO - Telehealth Services for Diagnosis Evaluation or Treatment of Symptoms of an Acute Stroke

Traditional CPT Telehealth Services

  • POS 02
Historically in-person services now provided via telehealth
  • Medicare Advantage and Commercial: The POS should equal what it would have been for in-person with modifier 95 to indicate provided by telehealth. See billing guidelines below.
  • BadgerCare: If the service is listed in Forward Health’s Topic #510, use POS 02 with appropriate modifiers of GT and/or 95 according to their guidelines. If service is not listed in Topic #510, use provider’s regular in-person POS with a 95 modifier. See flow chart below.

Billing Guidelines

Commercial and Medicare Advantage, follow CMS guidelines:

BadgerCare Plus, follow Forward Health billing guidelines: